Clinical characteristics, tongue manifestations, and traditional Chinese medicine syndrome patterns of spring influenza A in children: a single-center retrospective study.

Objective: To systematically analyze the clinical manifestations, dynamic changes in hematological parameters, traditional Chinese medicine (TCM) tongue characteristics, and syndrome differentiation patterns in children with influenza A during spring, so as to provide clinical evidence for the integrated Chinese and Western medicine diagnosis and treatment of pediatric influenza A in spring. Methods: A single-center retrospective study design was adopted. A total of 143 children who visited the Department of Traditional Chinese Medicine of our hospital in the spring of 2024 and 2025 and were initially diagnosed with influenza A were included. General information, initial symptoms, and symptom combinations were collected. Hematological parameters were measured, including white blood cell count (WBC), absolute neutrophil count (NEU), absolute lymphocyte count (LYM), neutrophil-to-lymphocyte ratio (NLR), procalc itonin (PCT), and C-reactive protein (CRP). According to disease duration, patients were divided into three stages: <1 d, >1-≤3 d, and >3-14 d, and trends of change were compared. Tongue characteristics including tongue color, coating texture, and coating color were recorded, and TCM syndrome differentiation types were statistically analyzed. Results: (1) General data and symptom characteristics: Among the 143 children, 78 were male (54.55%) and 65 were female (45.45%), with a mean age of (6.48 ± 3.61) years. The main age group was >5-≤10 years (64 cases, 44.76%). The mean disease duration was (1.82 ± 1.69) d, and 100 cases (69.93%) sought medical care within ≤1 d. Fever was the most common initial symptom (132 cases, 92.31%). The most frequent symptom combination was " fever + cough" (116 cases, 81.12%), followed by "fever + constipation" (85 cases, 59.44%). (2) Changes in hematological parameters: At the initial visit, 129 cases (90.21%) had LYM below the normal reference range, and 84 cases (58.74%) had elevated PCT. With disease progression, WBC showed a s light downward trend without statistical significance ( Conclusion: Spring influenza A in children was characterized by fever-dominant onset, frequent cough and constipation, early lymphopenia, dynamic inflammatory marker changes, and progressive tongue/coating changes across disease-duration stages. The observed increase in red tongue, thick coating, yellow coating, and heat-related TCM syndromes suggests a possible disease-duration-related shift toward intensified heat signs. These findings may provide exploratory reference for integrated clinical assessment, but they should be interpreted with caution because of the single-center retrospective design, small late-stage subgroup, absence of treatment/outcome data, and lack of standardized digital tongue imaging. Prospective multicenter studies are needed to validate these observations and clarify their clinical value.